Sick system: The scheme causing doctors to shun regional Australia

DOCTORS are being
offered the same cash incentives to work in tiny country towns as they are
bustling cities under a system diagnosed as a “monumental policy wreck”.

The federal
government is under growing pressure to dump its widely unpopular geographic classification scheme, which its opponents say has inadvertently removed the financial incentive
for many doctors to stay in the bush and put off potential new recruits.

The introduction of the ASGC-RA scheme in 2010 saw dozens of small communities put into the same category as
thriving regional centres like Hobart, Albury, Port Macquarie and Toowoomba.

The scheme is so
flawed a GP would be given more money to work in Cairns than the tiny
Queensland town of Cherbourg, which has just 1149 residents and is 300
kilometres from Brisbane. A doctor would also be given bigger incentives to practice
in a town just six kilometres up the road from Cherbourg.

“The only people
who can understand this monumental policy wreck are the people who work in
their ivory towers in Canberra,” said the Rural Doctors Association of
Australia president, Dr Paul Mara.

“What we know is,
on the ground, it’s doing nothing to help lift the number of doctors in the
bush.

A doctor in an
area classified ‘inner regional’ is currently entitled to relocation and
retention grants worth up to $27,000. Inner regional cities include Hobart - population
211,000, Toowoomba (120,000), Bendigo (86,000), Launceston
(80,000) and Wagga Wagga (61,000).

Dozens of small
towns with less than 10,000 people are lumped in the same inner regional category,
based on a mathematical formula developed by the Australian Bureau of
Statistics.

The formula relied
on an area’s proximity to big cities but largely ignored population size and lack
of essential services.

Affected towns
argue they need to at least be classified ‘outer regional’ to have any hope of
luring GPs. An outer regional area offers about $48,000 in potential incentive
grants.

Doctors fear
unless changes are made, precious health dollars will continue being spent
paying incentives to doctors in cities where there is little or no workforce
shortage. Some $34.9 million has been set aside to fund the scheme this financial
year.

A parliamentary
inquiry into the program will hand down its findings later this week, putting
pressure on the federal government to rethink how to best encourage more doctors
to abandon capital cities for country communities.

An instigator of
the inquiry, Nationals Senator Fiona Nash, has fielded near-universal
condemnation of the existing incentive scheme.

Senator Nash’s
hometown of Young, in south-western NSW, is also battling to attract doctors,
pitted against much larger regional health hubs like Wagga Wagga and Orange.

“As somebody from
a regional area, I know there’s nothing more important to regional Australians
than health but at the moment, we have an incentive scheme that isn’t helping
the doctor shortage,” she said.

“This is something the government can fix
quite easily but some don’t seem too interested doing it.”

The Department of
Health and Ageing did commission a review of the classification scheme in late
2010 after complaints started rolling in. The review found of 23 small towns
lumped into the same category as larger ones, just a handful had experienced a
“significant” improvement in GP numbers.

A department
spokesman this week conceded there was little data available to assess how
doctors had been influenced by incentives.

“The early data
is encouraging, however, showing that overall the number of doctors working in
regional, rural and remote areas…increased by almost seven per cent in the 15
months to 30 September, 2011,” he said.

“The data also
shows that there have been increases in the number of full time equivalent
doctors in the majority of large and small communities.”

Dr Mara claimed
those figures were not accurate.

“There may have been some increase in doctors
going to regional areas but they are invariably overseas trained doctors who
are forced to go there,” he said.

“Any country GP
will tell you the increase is not down to the remote classification scheme.”

Including Hobart
and other large cities had also distorted the number of doctors working in
rural and regional areas, he said.

The Australian
Medical Association (AMA) and Rural Doctors Association of Australia want incentives
based on a doctor’s level of isolation as well as whether or not they need to work
in hospitals and be on-call. The proposal would cost up to $400 million a year.

It’s understood
the Senate inquiry will recommend such a move but there are no guarantees the federal
government will implement it.

“We don’t think
that ($400 million) is an unreasonable amount and it could have a very big
impact,” said the AMA president, Dr Steve Hambleton.

Department of
Health and Ageing figures show there are as few as 47.1 GPs for every 100,000
people in the most remote areas. In major regional centres there are about 83.1
per 100,000 residents. In the nation’s capital cities, there are nearly 100 GPs
for every 100,000 inhabitants.

A
recent University of Melbourne study found doctors would want a salary bump of
between $68,000 and $237,000 to relocate to a country town. The study’s authors
also called for changes to the design of current incentive schemes.